Finding a Health Plan on the Marketplace
With the annual open enrollment period drawing to a close, we have some helpful tips to ensure you get health coverage before it’s too late.
Are there deadlines you should be aware of?
• Open enrollment lasts until January 31st- After that day you will not be able to purchase individual health insurance without a qualifying event. A qualifying event such as marriage, birth, or involuntary loss of group coverage will give you a Special Enrollment Period allowing you to purchase a plan even if it is not Open Enrollment.
• January 15th is the last day to enroll in a plan to receive an effective date of February 1st.
• If you enroll between January 15th and January 31st, you will have a March 1st effective date.
What to consider when looking at Marketplace coverage?
There are a few items to keep in mind when you are looking at Marketplace coverage:
1. Are you eligible for a subsidy?
-You will need to calculate your household’s modified adjusted gross income. If that amount falls between 100%-400% of the federal poverty level, you could be eligible for a subsidy. There is a worksheet on the healthcare.gov website that can assist you in calculating this amount. If you want help figuring this part out just give us a call.
-Are you eligible for affordable group coverage? If you are eligible for group coverage that is considered affordable you will not qualify for a subsidy. Affordability is based off of the employee only rate after employer contributions. If that rate is lower than 9.5% of your household income, spouses and dependents will not be eligible for a subsidy.
2. You must include income for any dependent required under IRS rules to file a federal tax return if you are claiming them as a dependent. (Unmarried, under 65 must file if they have earned income over $6,300).
3. Remember that there are only two health insurance carriers in the state of South Dakota that participate on the Marketplace, Sanford Health Plan and Avera Health Plan. Where you doctor may play a large role in deciding which plan you choose. If you doctor at both, you may have to choose.
4. If you choose not to purchase a health plan either on the marketplace or off, you will incur a penalty from the federal government. The fine for 2017 can be calculated as either a percentage of your household income or per person. You will pay which ever fine is higher.
-It could be 2.5% of your household income, up to the total yearly premium for the national average Bronze plan sold on the market place, or
-$695 per adult and $347.50 per child under 18 up to $2,085 for the year.
What should you bring to an appointment?
• Your social security number and those of any dependents.
• Your income information- from any and all sources of income.
• Your username and password if you have already set up a healthcare.gov account.
• Your email address and a password to set up an account if you are new to the marketplace. We will need to check your email for a link to authenticate a username.
• Your checking account information to set up payment for your new plan. Coverage will not be effectuated until the 1st month’s premium has been paid.
Simplify the process!
Many people find the process of acquiring health insurance on the marketplace to be confusing and frustrating as well as extremely time consuming. Working with a local agent can help make the process much more bearable. We can help you run all of your income information through the calculator to see if you qualify for a subsidy and, if you do not, we can help you find an alternative.
If you do not qualify for a subsidy you do not have to purchase your insurance through the marketplace. An agent will be able to help you find a plan off the exchange as well. Going off the exchange if you do not qualify for a subsidy can be simpler and easier than trying to work within the exchange.
If you are currently looking for health insurance give us a call at 1-800-669-3959 or 605-331-2100 and we can connect you to an agent in your area who can help you find coverage before the end of the Open Enrollment Period.